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This week, OraQuick received approval from an FDA advisory committee to move forward with its In-Home HIV Test, an over-the-counter kit which would uses oral fluid from a swab of the gums to detect HIV antibodies.

Supporters praise the development

Are Rapid Home HIV Tests A Good Idea?

as a means to inform people who are afraid or unable to go to a clinic about their status. But critics say it could give users a false sense of security, as the test cannot detect newly acquired infections, and encourage people to view a negative result as a free pass to engage in unsafe sex.

Also of concern: Getting your results from a professional means at least someone is there to offer counseling and comfort immediately. Finding out you’re HIV+ while standing in your pajamas in the bathroom would be quite the shock and could lead users to react impulsively.

Do those concerns outweigh the 45,000 infections that otherwise would remain unknown and lead to HIV spreading to another 4,000 people each year?

There is no right or wrong answer—so tell us what you think in the comments!

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28 Comments

Cam

Said…

“Finding out you’re HIV+ while standing in your pajamas in the bathroom would be quite the shock and could lead users to react impulsively.”
_______________________

I imagine that to anybody who went out, bought the test and took it may have occurred to them that the results could be positive. Would it really make a difference to have a touchy feeley school counselor type there talking about loving themselves etc…?

Seems like people finding out about unknown infections would far outweigh missing a conversation with Mr. Mackey.

May 16, 2012 at 2:05pm

J Bocca

Obviously the benefits outweight the “what ifs” If someone is going to hurt themselves over a positive HIV test then they are probably not stable to begin with. That’s like saying woman shouldn’t do at home breast exams because if they feel a lump they might do something irrational, are we really questioning the general populations sanity/self control?

May 16, 2012 at 2:05pm

Trent

Also, we have bars that offer HIV tests. That would be like saying that that is a bad environment to learn as well. I don’t think there is a good place to learn you are positive.

May 16, 2012 at 2:05pm

Aaron

I think that there is no easy answer to this. As someone that is HIV positive i have mixed feeling about this. When i tested positive i did not think it it would be a reactive result. I just did quartly tests just to be proactive. The benefit of having another person in the room that is trained to deal with a positive result is something that i could not have expected. And from a hiv prevention standpoint it is important to have someone there to make sure that you go for a blood draw to have the reactive result confirmed with a western blot, and then reported and to help you get linked into care. As having an undetectable viral load is so important for prevention. However, it would encurage more people to get tested. but knowing your status is worthless unless you know what to do after a rapid test.

May 16, 2012 at 2:05pm

EJC

These comments would be just too funny if they were not also so sad. Doesn’t anyone know an nice elderly gentleman we could fix this gay up this ?

May 16, 2012 at 3:05pm

Scott Amundsen

It is always good to make testing more accessible to as many people as possible. That being said, there are a few caveats to be observed.

1) From what I have been reading there are some accuracy issues with the home test; these must either be resolved or a warning to that effect included in the packaging.

2) There is a window between exposure and seroconversion. This means that one can be infected on Saturday and testing the following Monday will produce a negative result. Seroconversion can in fact take up to six months to occur; again, this needs to be addressed in the packaging.

3) The final thing to include in the packaging should be a set of instructions for those who test positive, starting with a strong suggestion to seek medical advice immediately. I’ve had HIV for twenty-three years and full-blown AIDS for eighteen and the more contact one has with one’s doctor, the better the outcome.

May 16, 2012 at 3:05pm

Mike

I have used home HIV test kits but they are the type that you give a blood sample and fed ex it into a lab and then call and get your results the next day.

May 16, 2012 at 3:05pm

Scott Amundsen

@Mike: These new ones are the swab-in-the-mouth kind like OraSure, which has been used in many testing centers for several years now. I am not certain if there are accuracy issues with OraSure, but I heard there are with this new home version.

May 16, 2012 at 3:05pm

Aaron

@ Scott i totally agree that there should be a comprehensive package insert that explains all of that. However, it is my fear that it will be disregarded and not read. I think that the accessibility of home tests will do great things to the increase in the number of people getting tested. But that does come at a cost. I just hope that people will actually read the provided information.

May 16, 2012 at 3:05pm

Nathan

Any opportunity for people to learn their current status is an important one. As a former HIV tester/counselor, I know that many folks were reluctant to get tested because of mandatory reporting laws that track by name who tests HIV+. Oraquick rapid tests are non-invasive and pretty easy to use, making them good products for home use. Of course having a tester/counselor available is great because it allows someone to explain the limits of the test(not an HIV test, but an HIV antibody test, a non-reactive test does not mean that you are immune to HIV, it takes at least 3 months for a body to produce enough HIV antibodies that the test will pick them up in your system, a reactive test does not mean someone is HIV+ but it would indicate that a confirmatory blood test would be the next step, etc.) and provide support/connection to resources, but people are ultimately responsible for their own health and are capable agents in supporting it. Also, not all testing agencies testers provide much in support or connections/referrals. You can be just as in shock and on your own with some testers than you are by yourself.

The concern that a negative result is a free pass to engage in unsafe sex seems alarmist. It takes at least two people to have sex and safety has to be negotiated. Ultimately, the only evidence you have someone else’s HIV status is their word, and they may not know it or want to tell you it, so individuals have to make the choice about how much risk they are comfortable experiencing given that we never know moment to moment our sex partners’ HIV status. At least with home tests, the some of the fear some people have of even learning their current status is alleviated, and people can take action to support their own health.

The more people who know their current status and have the capacity to engage in health promoting behaviors (and buying an HIV test is one) the better.

May 16, 2012 at 3:05pm

K!r!lleXXI

People are all different, and we will never be able to appease everyone. For some it will be a test that saves their life, for others it will be something that gives them false hope that they are going to be ok. Really, it always comes down to one simple thing: having a head on your shoulders and using it properly. Having a personal test available or not is not going to change the amount of gray matter or the efficiency with which the gyri are operating.

May 16, 2012 at 3:05pm

Shannon

Like the others said, there are good and bad sides to this.

Cam: HIV councilors are not just there to tell someone getting tested to love themselves. HIV councilors are trained to deal with the gamut of emotional responses HIV+ people can have (stretching from emotional breakdown to apathy and everything in between) but more important, they’re trained to appropriately read and administer the tests, and they’re trained to help people who DO test positive access all the services available to them … and no “included pamphlet” will ever replace someone who actually knows what local resources are available.

I think the biggest thing being overlooked by this is that OraQuick DOES NOT and CAN NOT actually diagnose HIV. You need a repeatedly reactive western blot test with a positive result (and a state HIV nurse) to actually diagnose HIV. Someone who has a reactive OraQuick needs followup tests to confirm the diagnosis.

Not to mention that the OraQuick tests are notoriously fickle when it comes to the environment they’re in. You buy an OQ test at the drugstore and leave it in your car all day before you test yourself? The result isn’t valid. Too cold? Result isn’t valid. Swabbed too lightly? No response. It’s more complicated than a pregnancy test (which people often compare it to).

We need to expand access to HIV testing, certainly, and in-home DIY HIV tests would be awesome. I’m not sure that this is the way to do it.

May 16, 2012 at 4:05pm

Scott Amundsen

@Shannon: If these OraQuick tests have as many accuracy issues as you say they do, it would be better not to market them at all.

May 16, 2012 at 7:05pm

Scott

“… and encourage people to view a negative result as a free pass to engage in unsafe sex.”

Seems to me someone is already engaging in unsafe behavior if (s)he is using an HIV test kit.

May 16, 2012 at 7:05pm

Rockery

Are they even accurate? If they can’t confirm HIV why bother, how would some test positive and not be positive?

May 16, 2012 at 8:05pm

David K

I have been an HIV Counselor for 20 years and even though I somewhat see the reasoining behind the decision to have an over the counter HIV test available there is still that very small chance that the test could be wrong. There are individuals out there who are extremely fragile and could possibly do harm to themselves or to someone else because of a false reading. I still feel face to face counseling and testing is the way to go.

May 16, 2012 at 9:05pm

Fitz

You know, I’m tired and cranky.. but here is my tired and cranky comment:

It’s 2012 already. I am totally tired of people who are afraid of knowing their freakin status. They endanger everyone else. I am not going to worry about their fragile little minds blowing up. They are a walking public health hazard.

If you have the guts to have sex, then you NEED to have the guts to get tested.

May 16, 2012 at 11:05pm

Mitch

Oh, it’s a GREAT idea. It’ll get ALL the people who don’t have the guts to show up at a real testing center! Everyone has a DUTY to get tested to PROTECT other people, and ANYTHING we can do to get MORE tests is BETTER, right?

…until YOU’RE the one whose positive result blindsides you, with nothing more than a stick of plastic and a customer service operator who’d rather be painting her nails fthan providing consolation. Suddenly, there are some rather glaring issues.

If someone isn’t mature/bold enough to go to a testing center, how are they supposed to be mature enough to handle a positive result? Alone? Perhaps while on a lunch break, or while a partner waits in the other room? If an HIV test is just too much strain for them, how the hell are they going to get hooked into the medical care that is neccessary? Counseling is a vital link in the testing process. Without it, all you have is a result that tells you nothing, that protects no one and that could promote suicidal or homocidal reactions.

Or do we, as Queerty readers, merely accept that the value of human life ends abruptly at “your test came back positive”? That’s what I hear when people like Fitz babble about hte “NEED” to get tested for “everyone”, without understanding the roller coaster of emotions that arise if the results come back as something other than “negative”.

I tested positive from Home Access. The post test counseling was a joke. There was no guidance to medical care, no emotional support, NOTHING. I was really lucky to live in a city with a fairly decent HIV support system, with friends who I hadn’t demonized for their status. If I’d been on my own, or if the result had come at a different time, things could have gone horribly wrong. I’ve heard similarly from other people who tested positive with home tests.

Justifying this test on the basis of “the need for testing” is to divorce the act of testing from anything that brings value to it, and implicitly, to wash our hands of the whole process in all its complexity. It demonstrates how little we value people who get “the wrong result”, and it neglects the reality that many of these people may not behave as we’d like them to. That’s right kiddos, a bitter faggot whose stick of plastic just told him he’s a pariah might not give a shit about YOUR heath. In fact, he might even be out to get you. Or you. Or YOU!

…Or he might just decide to enjoy his new status more than he should and go a little wild, quickly allowing himself to become a “hub” in our spoke/hub model of transmission. Hell, in his despair, he might even remove a condom behind your back.

“OH NO!”

Suddenly, when your precious lives could be affected, it isn’t such a good idea, is it? Gee, maybe we want to make sure that these people aren’t bitter, disaffected and filled with a sense that they’ve got nothing to lose.

And hey, maybe, after screaming that “everyone has a duty to test” without giving two shits about what happens afterward, you’ll find yourself swabbing your cheek on a lunch break one day, only to determine that you’ve had contact with one of these maniacs who went off the deep end without a life saver. I hope you remember that it was all part of your “obligation” to avoid being a “public health hazard”.

May 17, 2012 at 12:05am

jj

As long as there is a black box warning on the package explaining that the test is highly accurate for detecting HIV antibodies, but will not tell you if you have HIV if you have a recent infection, it would be okay. It isn’t enough to put this in small print on an insert, it needs to be in big bold letters on the box. Many infections take place during the acute viral phase when patients have extremely high viral loads, but aren’t yet making antibody.

May 17, 2012 at 1:05am

Frank

I’m wondering when more places are going to use fourth generation testing I heard the FDA just approved it in 2010 and over here in Europe it’s been available for years. It’s highly accurate and cuts down the window period and would help in diagnosing acute HIV infection.

May 17, 2012 at 2:05am

jason

This HIV detection kit is a money-making scheme from the greedy pharmaceutical company. In any case, HIV doesn’t cause AIDS. It’s a pointless test.

May 17, 2012 at 9:05am

Aaron

@ Jason your a fucking idiot.

May 17, 2012 at 11:05am

Good grief

These tests are absolutely a good idea. I hate, hate, hate asking my doctor for HIV testing. I would test myself more often with a home test. And I hate waiting days for the result. The fact that this test gives an immediate result is a huge factor in its favor to me. Also, to me it is important to be have complete control of my serostatus information if I should ever test positive, which is impossible if you get tested through a doctor.

May 17, 2012 at 11:05am

Scott Amundsen

In what universe? I have twenty-three years of personal experience that refutes that statement. Stop listening to quack theories and join us in the real world. Your belief is the most insidious and dangerous one of all in this pandemic.

May 17, 2012 at 12:05pm

jj

@Aaron: If you were engaging in unsafe sex which you obviously were, why were you expecting a quarterly test to come back negative? At this day and age, i no longer feel bad about gay men who become hiv+. There are thousands of innocent children born with hiv around the world every day, and then there are gay men who know the risks and yet STILL bareback.

May 17, 2012 at 2:05pm

Carlos

JJ-There are also A LOT of gay men who are HIV+ and still bareback and are in complete denial about how reinfection and getting infected with another strain of HIV, or infecting someone with another strain of HIV do happen.

Then there are the morons who are the “HIV-/DDF UB2” types who do it bareback or when they find out a sexual partner is HIV+ the first thing out of their mouths is “Give me your poz load!”

May 18, 2012 at 12:05am

Rob

There are also a lot of idiots who will claim that if you’re a raw/BB top that it’s fine and that you can’t get HIV this way or that being a BB/raw top is somehow “low risk” for HIV like giving oral sex is.

May 18, 2012 at 12:05am

Scott Amundsen

@Mitch: For Chrissakes calm down. There is a considerable difference between making testing more easily accessible to people who MAY or MAY NOT otherwise get tested, and telling the whole damn world that it is their “duty” to get tested, which I do not see here.

No one is forcing anything on anyone so far as I can see. As a person who tested positive back in the bad old days when the only way to do it was to go to a testing center and wait two agonizing weeks, I personally would prefer even now to have a counselor handy, and not over the phone either. That doesn’t mean the alternatives don’t work for some.

My only issue with these home tests is the question of accuracy, which seems to be a matter of considerable doubt. In which case the person would be compelled to seek more accurate testing as a follow-up anyway, which depending on your point of view might make the home test seem rather a waste of time.